发展中国家术后疼痛管理的观点、认知与经验：在卢旺达开展的一项焦点小组研究
Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda.
作者信息
Johnson Ana P, Mahaffey Ryan, Egan Rylan, Twagirumugabe Theogene, Parlow Joel L
出版信息
Pain Res Manag. 2015 Sep-Oct;20(5):255-60. doi: 10.1155/2015/297384.
BACKGROUND
Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes.
OBJECTIVES
In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies.
METHODS
The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management.
RESULTS
The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified.
CONCLUSIONS
The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations.
背景
术后急性疼痛治疗是围手术期护理的重要组成部分，通常由麻醉医生、外科医生、药剂师、技术人员和护士组成的多学科团队进行管理。在一些发展中国家，由于医疗资源稀缺、知识缺乏和文化观念等原因，治疗方式往往无法实施。
目的
在一项全面的知识转化计划之前，本研究旨在确定麻醉住院医师对术后疼痛管理策略的观点、看法和经验。
方法
本研究在卢旺达的一家大型教学医院采用定性评估策略进行。在相隔七天的两个时间段内，对基加利大学中心医院（卢旺达基加利）的麻醉住院医师进行了一次由10名参与者组成的半结构化焦点小组需求分析。使用解释性和描述性现象学方法对现场记录进行分析。参与者被问及他们在疼痛管理方面的观点、看法和经验。
结果
焦点小组的回答涉及五个一般领域：一般患者和医疗实践管理；术后疼痛管理的知识库；疼痛评估；与协议实施相关的机构/系统问题；以及对资源分配的看法。在这些领域中，确定了挑战（例如，利益相关者之间以及与患者的沟通）和机会（例如，在职培训、协议的使用、常规疼痛评估、参与资源分配决策）。
结论
本研究揭示了住院医师在实施术后疼痛管理策略中普遍感知到的挑战，并主要通过培训和实践建议的实施提供了克服这些挑战的实用建议。
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